Mehta Meeti, Douglas Nerone K O, Sarrami Shayan, Moroni Elizabeth A, De La Cruz Carolyn
From the Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Ann Plast Surg. 2025 Jul 1;95(1):39-45. doi: 10.1097/SAP.0000000000004341. Epub 2025 Mar 20.
Although access to post-breast cancer reconstructive surgeries continues to improve, inequities remain. This study uses Area Deprivation Index (ADI) to assess the impact of sociodemographic factors on access and utilization of breast reconstruction (BR).
This was a retrospective cohort of patients who underwent breast cancer surgery from 2014 to 2019. Patients were stratified by ADI, race, age, median household income, geography, and distance from the hospital. Summary statistics were computed, and multivariate regression was used to calculate odds ratios (OR).
A total of 2060 patients underwent mastectomy, of which 737 (36%) underwent immediate BR. For every one-unit increase in ADI, the odds of having BR decreased by 1.2% (OR, 0.988; CI, 0.985-0.992; P < 0.001). African American and Asian patients were significantly less likely to undergo reconstruction than other racial groups (OR, 0.669; CI, 0.456-0.963; P = 0.034 and OR, 0.341; CI, 0.114-0.819; P = 0.028, respectively). For every 1-year increase in age, the odds of receiving BR decreased by 5.6% (OR, 0.944; CI, 0.936-0.951; P < 0.001). For every $10 increase in median annual household income, the odds of having BR increased by 7.2% (OR, 1.007; CI, 1.005-1.009; P < 0.001). Rural patients were significantly more likely to receive reconstruction (OR, 1.391l; CI, 1.049-1.838; P = 0.021) than urban patients. As patients' distance from the hospital increased, White patients were more likely to receive BR (OR, 1.035; CI, 1.0003-1.0713; P = 0.048), whereas non-White patients were less likely to receive BR (OR, 0.965; CI, 0.933-0.999; P = 0.048). There were varying relationships between each measure of disparity and BR types.
Disparities in BR exist due to a sum of system-wide issues putting individual neighborhoods at highest risk.
尽管乳腺癌术后重建手术的可及性持续改善，但不平等现象依然存在。本研究使用地区贫困指数（ADI）评估社会人口因素对乳房重建（BR）可及性和利用率的影响。
这是一项对2014年至2019年接受乳腺癌手术患者的回顾性队列研究。患者按ADI、种族、年龄、家庭收入中位数、地理位置和距医院距离进行分层。计算汇总统计量，并使用多因素回归计算比值比（OR）。
共有2060例患者接受了乳房切除术，其中737例（36%）接受了即刻乳房重建。ADI每增加一个单位，进行乳房重建的几率降低1.2%（OR，0.988；CI，0.985 - 0.992；P < 0.001）。非裔美国人和亚裔患者接受重建手术的可能性显著低于其他种族群体（OR分别为0.669；CI，0.456 - 0.963；P = 0.034和OR，0.341；CI，0.114 - 0.819；P = 0.028）。年龄每增加1岁，接受乳房重建的几率降低5.6%（OR，0.944；CI，0.936 - 0.951；P < 0.001）。家庭年收入中位数每增加10美元，进行乳房重建的几率增加7.2%（OR，1.007；CI，1.005 - 1.009；P < 0.001）。农村患者接受重建手术的可能性显著高于城市患者（OR，1.391；CI，1.049 - 1.838；P = 0.021）。随着患者距医院距离增加，白人患者接受乳房重建的可能性更大（OR，1.035；CI，1.0003 - 1.0713；P = 0.048），而非白人患者接受乳房重建的可能性更小（OR，0.965；CI，0.933 - 0.999；P = 0.048）。每种差异衡量指标与乳房重建类型之间存在不同的关系。
乳房重建存在差异是由于一系列系统性问题导致个别社区面临的风险最高。
